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5 tips for treating carbon monoxide poisoning

The red flags and steps to take to make the scene safer for yourself, other responders and the patients


If the potential for carbon monoxide exists, evacuate immediately. Prevent curious bystanders and other rescuers from entering the home or structure.

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When cold temperatures arrive and winter precipitation increases, EMS must remind our communities – and our providers – to be vigilant about the dangers of carbon monoxide.

Every winter, people fire up old heaters that have not been used or maintained in many months. The indoor use of outdoor heat sources, such as gas grills or generators, and other inappropriate or illegal devices is a recipe for disaster.

For us responders, it’s time to remind ourselves about scene management issues as related to carbon monoxide.

1. Identify potential for an MCI

Unfortunately, there will probably be more than a few stories being reported this winter about first responders becoming ill while treating patients within a toxic environment. Stay alert! The vast majority of the time, the patient with a headache, nausea, vomiting and fatigue is in fact someone with flu or severe cold symptoms, but remember to consciously ask whether a heater is in use, and if so, where. Having more than one victim on the scene with similar signs is a red flag.

2. Evacuate!

If the potential for carbon monoxide exists, evacuate immediately. Prevent curious bystanders and other rescuers from entering the home or structure. Make the scene safer for yourself, other responders, and the patients by evacuating. A carbon monoxide monitor can provide key information and alert you to dangerous levels of CO.

3. Call for additional resources

If you can evacuate the patients safely, then do so; but your safety is the primary concern. If you are trained to use and have access to SCBA, retreat and don the necessary equipment to regain access safely. If not, call for additional resources and prepare to receive the patients out in the cold zone.

4. Understand the pathophysiology of CO

Carbon monoxide kills by robbing hemoglobin of its ability to hold oxygen. This causes the patient to effectively suffocate. High concentrations of oxygen can begin the process of bumping carbon monoxide molecules off the hemoglobin cells. Assess if the patient is ventilating effectively – look for adequate rate and depth of breathing. Don’t trust your pulse oximeter, as it will show abnormally high readings.

5. Follow local protocols for transport to a hyperbaric chamber

In more severe cases of CO poisoning, a facility that has access to a hyperbaric chamber may be needed. Oxygen under increased atmospheric pressure will help drive more CO off the hemoglobin. Review your destination policies and procedures to make sure you are transporting to the appropriate facility.

This article, originally published on Nov. 30, 2010, has been updated.

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of “EMT Exam for Dummies,” has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at and connect with him on Facebook or Twitter.